Cost-effectiveness Analysis of Endoscopic Retrograde Cholangio-pancreatography and Surgery in the Treatment of Common Bile Duct Stone or Combined with Gallbladder Benign Lesions_West China Medical Journal

Authors：

 TAOLi-ping , LIXiao , CHENLin , WUChun-cheng , HUBing ,  WANGChun-hui

Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

WANGChun-hui, Email: chwangsc@yahoo.com

Keywords：

Common bile duct stone; Endoscopic retrograde cholangio-pancreatography; Laparoscopy; Laparotomy; Cost-effectiveness

DOI：

10.7507/1002-0179.20140555

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To compare the cost-effectiveness between endoscopic retrograde cholangio-pancreatography (ERCP) treatment and laparotomy treatment for simple common bile duct stone or common bile duct stone combined with gallbladder benign lesions. Methods A total of 596 patients with common bile stone received ERCP (ERCP group) and 173 received open choledocholithotomy (surgical group) in our hospital between January 2009 and December 2012. Their clinical data were retrospectively analyzed. The curing rate, postoperative complications, hospital stay, preoperational preparation and total cost were compared between the two groups of patients. Meanwhile, for common bile stone combined with gallbladder benign lesion, 29 patients received ERCP combined with laparoscopic cholecystectomy (LC) (ERCP+LC group), 38 received pure laparoscopy treatment (laparoscopy group) and 129 received open choledocholithotomy combined with cholecystectomy (surgery group). Results For simple common bile stone patients, no significant difference was found in cure rate and post-operative complication between endoscopic and surgical treatment groups (P>0.05). However, total hospitalization expenses[(13.1±6.3) thousand yuan, (20.6±7.5) thousand yuan)], hospital stay[(8.91±4.95), (12.14±5.15) days] and preoperative preparation time[(3.77±3.09), (5.13±3.99) days] were significantly different between the two groups (P<0.05). For patients with common bile stone combined with gallbladder benign lesion, no significant discrepancy was detected among the three groups in curing rate and post-operative complications (P>0.05). Significant differences were detected between ERCP+LC group and surgical group in terms of total hospitalization expense[(18.9±4.6) thousand yuan, (23.2±8.9) thousand yuan] hospital stay[(9.00±3.74), (12.47±4.50) days] and preoperative preparation time[(3.24±1.83), (5.15±2.98) days]. No significant difference was found in total hospitalization expense and hospital stay, while significant difference was detected in preoperative preparation time between ERCP+LC group and simple LC group. Conclusion For patients with simple common bile stone, ERCP is equivalent to surgery in the curing rate, and has more advantages such as less cost, shorter length of hospital stay, and lower preoperative preparation time. For the treatment of common bile duct stone with gallbladder benign disease, ERCP combined with LC also has more advantages than traditional surgery.

Citation： TAOLi-ping, LIXiao, CHENLin, WUChun-cheng, HUBing, WANGChun-hui. Cost-effectiveness Analysis of Endoscopic Retrograde Cholangio-pancreatography and Surgery in the Treatment of Common Bile Duct Stone or Combined with Gallbladder Benign Lesions. West China Medical Journal, 2014, 29(10): 1823-1826. doi: 10.7507/1002-0179.20140555 Copy

1.	張振中, 孫源源, 昭建國, 等. 十二指腸鏡治療膽總管結石與腹腔鏡和外科手術的成本-效果分析[J]. 中國醫師進修雜志, 2011, 34(8):55-57.
2.	Clayton ES, Connor S, Alexakis N, et al. Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ[J]. B J Surg, 2006(93):1185-1191.
3.	Yoshida K1, Yamazaki Y, Mizuno R, et al. Laparoscopic splenectomy in children. Preliminary results and comparison with the open technique[J]. Surg Endosc, 1995, 9(12):1279-1282.
4.	Sgourakis G, Lanitis S, Karaliotas CH, et al. Laparoscopic versus endoscopic primary management of choledocholithiasis. A retrospective case-control study[J]. Chirurg, 2012, 83(10):897-903.
5.	李俊達, 何劍琴. 內鏡治療膽總管結石與傳統手術的療效分析[J]. 中國內鏡雜志, 2007, 13(7):705-707.
6.	蘇秉忠, 陳平, 宋建忠, 等. 膽總管結石內鏡和手術治療效果的對照分析[J]. 現代消化及介入診療, 2007, 12(4):228-231.
7.	許卓明, 蘇樹英, 甄作均, 等. 腹腔鏡膽總管切開術與內鏡括約肌切開術治療膽總管結石的比較[J]. 中華普通外科雜志, 2007, 22(6):410-412.
8.	Lu J, Cheng Y, Xiong XZ, et al. Two-stage vs single-stage management for concomitant gallstones and common bile duct stones[J]. World J Gastroenterol, 2012, 18(24):3156-3166.
9.	Bansal VK, Misra MC, Rajan K, et al. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones:a randomized controlled trial[J]. Surg Endosc, 2014, 28(3):875-885.
10.	Alexakis N, Connor S. Meta-analysis of one-vs two-stage laparoscopic/endoscopic management of common bile duct stones[J]. HPB (Oxford), 2012, 14(4):254-259.
11.	Dasari BV, Tan CJ, Gurusamy KS, et al. Surgical versus endoscopic treatment of bile duct stones[J]. Cochrane Database Syst Rev, 2013, 9:CD003327.
12.	Zang JF, Zhang C, Gao JY. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy during the same session:feasibility and safety[J]. World J Gastroenterol, 2013, 19(36):6093-3097.
13.	Jones M, Johnson M, Samourjian E, et al. ERCP and laparoscopic cholecystectomy in a combined (one-step) procedure:a random comparison to the standard (two-step) procedure[J]. Surg Endosc, 2013, 27(6):1907-1912.

1. 張振中, 孫源源, 昭建國, 等. 十二指腸鏡治療膽總管結石與腹腔鏡和外科手術的成本-效果分析[J]. 中國醫師進修雜志, 2011, 34(8):55-57.
2. Clayton ES, Connor S, Alexakis N, et al. Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ[J]. B J Surg, 2006(93):1185-1191.
3. Yoshida K1, Yamazaki Y, Mizuno R, et al. Laparoscopic splenectomy in children. Preliminary results and comparison with the open technique[J]. Surg Endosc, 1995, 9(12):1279-1282.
4. Sgourakis G, Lanitis S, Karaliotas CH, et al. Laparoscopic versus endoscopic primary management of choledocholithiasis. A retrospective case-control study[J]. Chirurg, 2012, 83(10):897-903.
5. 李俊達, 何劍琴. 內鏡治療膽總管結石與傳統手術的療效分析[J]. 中國內鏡雜志, 2007, 13(7):705-707.
6. 蘇秉忠, 陳平, 宋建忠, 等. 膽總管結石內鏡和手術治療效果的對照分析[J]. 現代消化及介入診療, 2007, 12(4):228-231.
7. 許卓明, 蘇樹英, 甄作均, 等. 腹腔鏡膽總管切開術與內鏡括約肌切開術治療膽總管結石的比較[J]. 中華普通外科雜志, 2007, 22(6):410-412.
8. Lu J, Cheng Y, Xiong XZ, et al. Two-stage vs single-stage management for concomitant gallstones and common bile duct stones[J]. World J Gastroenterol, 2012, 18(24):3156-3166.
9. Bansal VK, Misra MC, Rajan K, et al. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones:a randomized controlled trial[J]. Surg Endosc, 2014, 28(3):875-885.
10. Alexakis N, Connor S. Meta-analysis of one-vs two-stage laparoscopic/endoscopic management of common bile duct stones[J]. HPB (Oxford), 2012, 14(4):254-259.
11. Dasari BV, Tan CJ, Gurusamy KS, et al. Surgical versus endoscopic treatment of bile duct stones[J]. Cochrane Database Syst Rev, 2013, 9:CD003327.
12. Zang JF, Zhang C, Gao JY. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy during the same session:feasibility and safety[J]. World J Gastroenterol, 2013, 19(36):6093-3097.
13. Jones M, Johnson M, Samourjian E, et al. ERCP and laparoscopic cholecystectomy in a combined (one-step) procedure:a random comparison to the standard (two-step) procedure[J]. Surg Endosc, 2013, 27(6):1907-1912.

West China Medical Journal

Cost-effectiveness Analysis of Endoscopic Retrograde Cholangio-pancreatography and Surgery in the Treatment of Common Bile Duct Stone or Combined with Gallbladder Benign Lesions

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content